Combat Medicine in Literature

The arts of taking and preserving life have been irrevocably intertwined since their genesis. By considering the works of Louisa May Alcott and Whitman’s “The Wound Dresser” along with Homer’s Iliad we can attempt to gain perspective on the development of battlefield medicine across the span of almost 3 millennia.

The Iliad offers the most famous account of Bronze Age warfare and also provides a unique insight into that era’s battlefield trauma care. Machaon, arguably the greatest physician among the Achaeans, earns his reputation due to the superlative skill with which after “seeing the wound where the painful arrow entered, he sucked out the blood, then skillfully smoothed on salve.”[1] From this brief description of treatment in combat zones it is possible to conclude that Bronze Age physicians had developed at least a rudimentary theory of hygiene and were well practiced in surgical excision of foreign objects especially “the cutting out of arrows from wounds.”[2]

In comparing civil war surgeons with their ancient forebears we put to proof the idea that medicine is not a continual progressive march. Alcott notes rather than skillful excision, amputation represented essentially the sole recourse for serious injuries from firearms. While this was in part due to the difference in weaponry, a complicating factor was that “the merciful magic of ether was not thought necessary…so the poor souls had to bear their pains.”[3] As a consequence of the speed such surgeries required the medical record leave us with accounts such as one in which a surgeon “amputated the leg in 21⁄2 minutes, but in his enthusiasm the patient’s testicles as well.”[4] Clearly, three millennia had done little in ameliorating or had perhaps even augmented the brutality of combat traumatology.

In our modern era, the questions of how we care for our injured soldiers continues to be among the most central facing our society. Undoubtedly, technical skill has advanced enormously since the civil war and would seem almost divine to the Bronze Age Greeks. In light of the recent scandals at the VA however, we must be careful not to lose the soul of medicine as its body grows. As important as the treatment if not more so, are the motivations of those providing it.

From Ilium to Vicksburg the commitment to guiding “gently down into the Valley of the Shadow” has served as a uniting thread of palliative care across the ages.[5] When Machaon himself received an incurable wound from Eurypylus, and the physician cannot answer the call to treat himself, the Greeks offer their top physician, “a cup of hot wine sprinkled with grated goat cheese and barley” to ease his passing.[6] Whether it involves “washing faces, serving rations, giving medicine” or volunteering to “remove the slough” (wash off the matter and blood) Alcott and “The Old Wound Dresser” demonstrate the same impulse is alive and well in the 19th century. While always a vital guiding principle the idea that “a good physician treats the disease; a great physician treats the patient who has the disease” is never more important than when those we depend on to be our strongest are left vulnerable by injury or disease.

Adil

Third-Year at Case Western Reserve School of Medicine

Adil Menon is a student at Case Western Reserve School of Medicine. Before medical school, he received his Master of Bioethics degree from Harvard Medical School.
His written work includes Joseph Goldberger: Epidemiology’s Unsung Hero and Is There a United Hippocratic School? in Hektoen International, a book review of The American Healthcare Paradox in HMS Bioethics Journal, and Geographic Disparities in Reported US Amyloidosis Mortality From 1979 to 2015 Potential Underdetection of Cardiac Amyloidosis in JAMA Cardiology.
For fun he enjoys dragon boat racing, listening to podcasts and reading, especially science fiction and fantasy.

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